gms | German Medical Science

Objective: Chronic headache syndromes are one of the major problems in health care systems of all industrial countries. Despite of any treatment option a certain group of patients remains refractory and no sufficient pain reduction and quality of life can be achieved. Minimal invasive treatment with neuromodulation of the major occipital nerves is approved for certain indications. A single-centre clinical experience is presented.

Method: Classification and diagnosis of the headache syndromes by experienced headache specialists was according the International Classification for Headache Disorders (ICHD). All patients had a long lasting history of headache and multiple unsuccessful or insufficient treatments. In these patients a test trial with subcutaneous leads and stimulation of the greater occipital nerve (ONS) was performed for 4-12 days as a test trial. A total number of 60 patients were operated, in detail 13 patients with chronic cluster headache (CCH), 25 with chronic migraine (CM), 18 patients with combined CCH and CM and 4 patients with occipital neuralgia (ON).

Results: Effective stimulation of the greater and sometimes of the minor occipital nerve (ONS) was achieved in all patients under local anaesthesia. Test trialling was performed with an external stimulation device to evaluate a positive effect of the stimulation on the chronic headache. Patients reported a variety of effects ranging from no alteration up to pain reduction of nearly 100%. In the majority of the patients a reduction of pain attack frequency, intensity and duration was obvious. Also complications with lead dislocation, breakage of the leads or extensions and wound infection at the surgical sites were seen.

Conclusions: ONS is a novel neuromodulatory approach to achieve a significant pain reduction in refractory chronic headache patients. ONS should be offered to patients with chronic migraine, cluster headache, tension headache and occipital neuralgia. At the moment there is no significant evidence and grade of recommendation, but a review of the literature evaluates the current positive results of the published studies. A multi-centre prospective randomized trial comparing ONS with best medical and conservative treatment is urgently needed.